AN ROINN OIDEACHAIS AGUS SCILEANNA APPLICATION FOR

AN ROINN OIDEACHAIS AGUS SCILEANNA
APPLICATION FOR THE TEACHER PROFESSIONAL VISIT TO FRANCE
SCHEME 2015/2016
Attach Photograph
PART 1 -
A.
to be completed by the applicant. Please type this form or complete it
in BLOCK LETTERS using black ink. A recent passport type photo
must be attached to the space above. The contact details given will be
transmitted to the French parties concerned who may make direct
contact and seek supplementary information.
Surname:
___________________
First Names: ________________
Home Address: _________________________________________________
______________________________________________________________
Email Address: _________________________________________________
Date of Birth: _____________
Contact No: __________________________
PPSN : _________________________
Are you currently registered with the Teaching Council? _________________
Teaching Council Registration Number: ______________________________
B.
(i)
Name and Address of school in which you are serving
________________________________________________________
________________________________________________________
Phone No: _______________________
Email Address: ___________________________________________
School website: _____________________
Roll Number: ______________
Name of Principal: _________________________________
(ii)
Number of Pupils: Boys _______ Girls________ Total _________
Number of students studying French: _______________
(iii)
Current Timetable
Total hours per week
______________________________
Total periods per week
______________________________
Subjects taught and classes ______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
(iv)
List in chronological order details of your teaching service to date,
giving names of schools, classes and subjects taught:
________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
C.
(i)
Qualifications (give date, place obtained,
level of award and subjects studied) _________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
(ii)
Registered subject(s): (Teaching Council):_________________
(iii)
In-service training courses
completed:_______________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
(iv)
Details of periods of a month or more spent abroad: _______________
________________________________________________________
_______________________________________________________
________________________________________________________
(vi)
Have you ever taught English as a
foreign language?
YES/NO
If yes, please state period and
age of students
________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
_________________________________________________________
_________________________________________________________
D. Has your school in Ireland previously participated as a Host School and has it
received a teacher from France under this scheme? __________________
If the answer to the above is YES, and the teacher of French wishes to
arrange a return visit to the visiting teacher’s school, then both the Irish
teacher and the French school must submit an application form to the
relevant authorities if they wish to be considered for the scheme.
Please provide the name, address and contact email address of any particular
school in France which you have a preference to visit and the basis for this
preference e.g. existing twinning or e-twinning link with your home school.
Name and Address of school in France:_____________________________
____________________________________________________________
____________________________________________________________
Email Address: ___________________________________________
Basis for preference of above school: ______________________________
____________________________________________________________
Has the school submitted an application form to the relevant French authority?
______________________________________________________________
Alternatively, please indicate any particular preference you may have as to
location or type of school in France: _________________________________
______________________________________________________________
E.
Please state your preferred dates for participation in the French/Irish Teacher
Professional Visit Scheme for the 2015/2016 school year (Teachers must
arrange their visits at times which will necessitate only one week’s absence
from their schools during term time by, for example, taking the second week
during a time of closure for their home school, such as a mid-term break).
Please consult the dates agreed for school holidays/closures in 2015/16 on
the Department’s website.
____________________________________________________________
_____________________________________________________________
_____________________________________________________________
F.
Please give an outline of the project you would hope to undertake with the
partner school:
______________________________________________________________
______________________________________________________________
G.
Any further details you wish to have taken into account in support of your
application:
______________________________________________________________
______________________________________________________________
Declaration:
I have read the terms and conditions governing the scheme for teacher
professional visits with France. I agree to be bound by them. If my
application is successful, I shall be prepared to participate in the scheme and
to fulfil all the associated duties.
Signature of Applicant: ___________________________________________
Date: ___________________
Notification of the result of your application will be conveyed via email by the 15th
May 2015.
PART II
To be completed by School Authorities:
I am prepared to release the applicant for the duration of the exchange mentioned
above.
Signature: _____________________________Signature:____________________________
*MANAGER/PRINCIPAL
Signature of the CE of the Education
and Training Board if you are an ETB
teacher
Date: ___________________
School:
______________________________ETB: ________________________
Tel Number of the ETB: _______________________
* Delete word not applicable.
This form should be returned to:
French/Irish Teacher Professional Visit Scheme, Teacher/SNA Terms and Conditions,
Department of Education & Skills, Athlone, Co. Westmeath
Closing date for receipt of applications: Friday , 13th February, 2015.
Data Protection
The Department of Education and Science will treat all personal data you provide
on this form as confidential and will use it solely for the purpose intended. The
information will only be disclosed as permitted by law or for the purposes listed in
the Departments registration with the Data Protection Commissioner - REF
10764/A
If the information you have provided is to be used for purposes other than outlined
in the Departments registration with the DPC your permission will be sought.